Provider Demographics
NPI:1578852554
Name:WHITE, CRYSTAL MITCHELL (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MITCHELL
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6200
Mailing Address - Country:US
Mailing Address - Phone:919-556-2905
Mailing Address - Fax:919-556-1469
Practice Address - Street 1:12225 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6200
Practice Address - Country:US
Practice Address - Phone:919-556-2905
Practice Address - Fax:919-556-1469
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist